Which pump is the best?

Does the pump know my sugar level and automatically deliver the right amount of insulin?

No! At this time, insulin pumps cannot measure glucose levels and cannot automatically deliver the right amount of insulin.

Do I have to be attached to the pump all the time?

It is possible to temporarily disconnect yourself from the pump, but not for very long. If you are disconnected for more than an hour, you may need to replace your missed insulin. Once again, speak with your doctor about specific recommendations. It is important to assess the entire picture.

What type of insulin is used in an insulin pump?

Insulin pumps use rapid-acting insulins such as lispro, aspart and glulisine. Because the pump delivers tiny amounts of insulin every few minutes, longer-acting insulins are not necessary.

Should I go on the pump?

Insulin pumps can greatly benefit people with diabetes. However, not everyone with diabetes is a good pump candidate. Psychological readiness and physiological needs vary with individuals and need to be considered.

How much time and effort commitment does pump therapy require?

Starting pump therapy requires commitment. It is not unusual to check blood sugars 8-12 times per day in the beginning of pump therapy to assess basal and bolus insulin needs. This often means lots of interruptions during the workday and during family time. It also means disturbing your sleep in order to take blood sugar readings in the middle of the night. Think about your schedule and commitments. Talk to your family for support. Plan ahead.

What expectations should I have?

Make sure you have realistic goals on what pump therapy can achieve. It takes a lot of work with injections to achieve the best glucose control. The same is true with an insulin pump. Pump therapy does not automatically fix a problem. It takes time and effort. However, the pump does provide more tools to help.

Knowledge and skills you’ll need to have:

A thorough understanding of diabetes self-management skills:

You should understand insulin action, carbohydrate counting and how to treat high and low blood sugars.

Manual dexterity:

Manual dexterity is necessary to load or fill an insulin cartridge and depress buttons on the pump for technical functions. Severe limitations from hand arthritis or neuropathy may hinder this.

Vision:

People with vision impairment should carefully evaluate which pumps may be the most helpful for them. Pump features such as screen size, screen contrast, size of letters and numbers, audio functions, alerts, alarms, and backlighting should all be assessed.

What’s so great about the pump?

The list is an important one, in large part because pumps provide more precise and tailored insulin delivery. As a result, they offer greater lifestyle flexibility. Tailored insulin delivery can help:

The “dawn phenomenon” – by matching your early-morning increase in insulin resistance, so you avoid high blood sugar.

What’s not so great about the pump?

There are downsides to any therapy, and the insulin pump is no exception.

Wearing it can be unsettling

Most of the time, you’ll be wearing your pump on your body, clipped to your waistband or in your pocket. Fortunately, many accessories are available to make wearing the pump discreet and convenient.

Cost

Insulin pumps cost thousands of dollars. Insurance coverage for insulin pumps varies. Some companies will cover all of the cost, while others may cover only half. Some might also pay for only certain brands. Don’t forget to factor in the cost of disposable items, such as cartridge syringes, infusion sets and skin preparation items.

Higher risk for ketoacidosis

There is a greater risk for ketoacidosis in pump therapy, because long-acting insulin is not used. Because of this, high levels of ketones may develop when there is not enough insulin in the bloodstream. This can happen if there is air in the tubing, a bad infusion set, insertion site infection, or if the insulin pump is disconnected for too long. See also Ketones and pump therapy. As a result, ketoacid levels rise, which can lead to diabetic coma.

Risk of infusion site infection

Infections can occur if an infusion set is left in for too long. To lessen your chance of infection, change the set as directed by your doctor or pump educator. It is also crucial to wash your hands and the site properly in order to reduce chances of infection. See also Infusion set tips.

What should be considered when choosing an insulin pump?

The following list may seem formidable and long, but keep in mind that not all of it may apply to you. Discuss which features and elements are most relevant to your care with your doctor.

Weight, size and color of pump

Lowest basal rate delivery

Amount of insulin a cartridge can hold (e.g. 160 units or 200 units or 300 units of insulin)

Number of different background, or basal, insulin patterns available (e.g. weekday, weekend, night shift, exercise day, day of week, etc.)

Insulin-to-carbohydrate ratio program feature

Insulin-sensitivity factor and target glucose features

Number of different customized bolus programs available – for example: breakfast, lunch, dinner, pizza, use of pramlintide, etc.

Nutritional information

Insulin-on-board feature

Types of alarms and alerts

Waterproof, watertight, or water-resistant

Ease of use – programming, delivering a bolus, navigating program menus

RN – 3 to 6 visits or more to verify self-management strategies. The last appointment must be within 4 weeks of starting the pump. Prior diabetes comprehensive diabetes management education is required and may include the Diabetes Teaching Center Insulin Workshop

MD – 2 to 3 visits or more to maximize glucose control on injections and determine future pump settings. The last appointment must be within 4 weeks of starting the pump

Pump educator – 2 to 4 visits or more to learn technical use of the pump and infusion set insertion

Manufacturer’s Pump Trainer – 1 visit approximately 1 week prior to your class to learn how to operate your pump and go on a trial of saline in the pump.

II. Starting on the pump: (timeline two ½ day classes)

You will attend an insulin pump start class on two consecutive mornings taught by certified diabetes educators. This is when you will start pumping insulin.

III. Follow up: (timeline 2 to 4 weeks)

Make appointments with pump team

MD – 2 to 5 visits or more

RN – 2 to 4 visits or more

RD – 0 to 2 visits or more

Once you are given the dates for your pump class be sure to schedule your pump team follow up appointments.

Self-assessment Quiz

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